The CMO's broad strokes need refinement

The CMO's much delayed and greatly anticipated report on medical regulation is long on words, but short on the details of how the vision of fitness-to-practise and relicensing will actually work.

The report's 200-plus pages outline in broad strokes a greatly changed role for a reduced GMC, which will become the policeman of medical regulation, investigating fitness-to-practise issues.

The report states it will be helped by its very own special constables to be known as 'GMC affiliates'. These will be practising doctors able to assess cases at a local level, and where appropriate, issue a caution in the form of 'recorded concerns' or refer the case upwards to the GMC.

How these affiliates will be chosen has yet to be outlined.

The standards doctors will be judged against will be established by an effective legislature including the royal colleges, the GMC and the Postgraduate Medical Education and Training Board. The GMC is to lose its adjudication role to a yet-to-be-defined body made up of lawyers, doctors and lay members.

This body will take a civil court approach, deciding cases on the balance of probabilities.

The approach to revalidation faces an equally significant shake-up which again reduces GMC involvement. The ongoing regular assessment of doctors will now be divided into two, with the GMC responsible for the relicensing of doctors every five years on the basis of appraisals and any reports from the local affiliate.

The royal colleges will set the standards and process for recertifying doctors in their relevant specialty. These more stringent criteria are likely to combine continuing development with specific tests, such as knowledge tests or simulated surgeries. But until the RCGP reveals its hand, it is impossible to know what will be expected of GPs.

The CMO, Sir Liam Donaldson, acknowledges both that the GMC is regarded as a good model of medical regulation by other countries, and that the body has been subject to criticism both from the media and doctors. The intention of these reforms, therefore, should be to build upon that model of good practice and to regain the confidence of the public and profession in the regulatory process.

With so much still open to consultation and confirmation, it is difficult to judge whether these reforms will achieve that aim, or turn out to be a cosmetic exercise in deckchair arrangement. There is an opportunity to create a system that will last for as many years as the current regime but only if there is clarity over how those serving in the new layers of regulation are appointed, and if the whole profession is involved in and supportive of the creation of new standards.

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